Introduction: Duplication of the renal system is the most common congenital anomaly of the kidneys. There is an increased incidence of surgical treatment of nonfunctional moieties.1 Near infrared fluorescence (NIRF) with indocyanin green (ICG) has been reported to be feasible in facilitating super-selective clamping for zero ischemia partial nephrectomies for renal cell carcinoma.2 ICG has also been previously described for selective arterial mapping in pediatric patients with duplex kidneys undergoing robot-assisted laparoscopic heminephrectomy.3 We evaluated the utility of NIRF for intravenously injected ICG (Akorn, Lake Forest, IL) in performing robot-assisted laparoscopic partial heminephroureterectomy for adult patients with duplicated renal systems with an aim to spare any ischemia to nondiseased moiety. Materials and Methods: Two patients, both with obstructed and infected upper moieties, presenting with flank pain underwent this procedure at our center for a 3-year period. Preoperative Double-J stenting of lower moiety ureter was performed for better delineation during the ureteral dissection. They underwent robotic procedures with da Vinci Si Surgical system. After dissecting the affected upper moiety vessel branches of the renal artery and clamping them selectively, ICG was administered as an intravenous bolus by the anesthesiologist. It was prepared in a 2.5 mg/mL solution at beginning of the case, with 3 mL administered within 1 minute of clamping the vessels. The recommended daily maximum dose of 2 mg/kg was not exceeded. Karl Storz Spies lens with NIRF filter was used for detection of fluorescence as previously described in other series.4 On administration, the robotic camera light was immediately turned off and the lens was inserted through an assistant port. Delineation of a zone of ischemia was confirmed and subsequently by visual extrapolation the affected moiety was resected. Renorraphy was performed in two layers with sliding Hem-o-lok technique. Robot was repositioned caudally for the ureteral dissection. Results: Both patients were females and their mean age was 26 years. Preoperative renal function was normal. Average length of surgery was 278 (245–310) minutes. Mean blood loss was 100 mL. Average length of stay was 4 days. There were no perioperative complications and no loss of renal function postoperatively. Conclusion: The unique features of robotic technology with ICG assistance offered enhanced dexterity and vision, facilitating the management of complex vascular and ureteral anatomy, while maintaining zero renal ischemia. Our results demonstrate the feasibility and safety of this technique. We believe it is especially useful for patients with solitary duplex kidneys or those with background chronic renal impairment for whom preservation of nephrons is paramount. No competing financial interests exist. Runtime of video: 6 mins